MAHA's silence on tobacco

Politico

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With Robert King and Erin Schumaker
Driving the day
A REPORT OMISSION — HHS Secretary Robert F. Kennedy Jr.'s Make America Healthy Again report did little to discuss one of the biggest contributors to chronic disease and the leading cause of preventable death in the United States: smoking.
Kennedy's apparent lack of interest in combating smoking — the word 'tobacco' appears in the MAHA report only within the context of his concerns about food marketing, while 'smoking' and 'cigarettes' are never mentioned — also suggests this Trump administration won't be like the first.
Then, Trump's FDA Commissioner Scott Gottlieb put forward a plan to limit menthol cigarette sales and place limits on nicotine levels, drawing applause from anti-smoking activists.
An HHS spokesperson said the department 'remains steadfast in its mission to protect and promote public health,' adding that the MAHA report is not an 'exhaustive inventory of every HHS program or public health challenge.'
'HHS agencies continue to carry out their responsibilities, including work on tobacco control, with the highest level of integrity and commitment to the American public,' the spokesperson said.
Still, public health experts, former government health officials and some lawmakers fear deemphasizing the dangers of tobacco could slow or even halt progress in driving down smoking rates.
'Attempting to combat chronic disease without tobacco control is like attempting a triathlon without a bicycle,' said Brian King, whom Kennedy pushed out of his job as the FDA's top tobacco regulator in April. 'You're destined for failure before leaving the starting line.'
After Gottlieb resigned in March 2019, the agency's efforts to advance his 2017 tobacco plan were snuffed out.
'With his resignation, we lost the champion for the 2017 plan, and some months after he resigned, I was literally ordered by political appointees at FDA to stop talking publicly about menthol and nicotine,' said Mitch Zeller, who led the FDA's Center for Tobacco Products before King.
Jerome Adams, who was surgeon general during the first Trump term, said he wants Kennedy to prioritize the tobacco regulations laid out in Gottlieb's tobacco regulation plan — an effort he said would benefit youth and marginalized communities that are disproportionately impacted by menthol cigarettes.
'These proposed regulations align with the MAHA movement's focus on preventing chronic diseases,' Adams said.
It's Wednesday. Welcome back to Pulse. CMS Administrator Mehmet Oz turns 65 today — and is using his birthday to show future Medicare enrollees how to sign up for Medicare. Resident FDA reporter David Lim here, pinch-hitting Pulse today. Send tips and feedback to [e-mail]!
In Congress
GOP BACKS OFF MEDICARE CHANGES — Sen. Kevin Cramer (R-N.D.) said Tuesday he doesn't expect Republicans to include Medicare changes in their reconciliation package, POLITICO's Jordain Carney and Robert report.
When asked whether he expects Medicare changes to make it into the massive tax and spending package, Cramer replied, 'I don't know that I do. There aren't many of us courageous enough to talk about it.' He also acknowledged that his previous remarks sparked 'a lot of angst.'
The public shift comes after GOP senators caught their own colleagues off guard — and gave Democrats a new political target — when they opened the door last week to going after 'waste, fraud and abuse' within the program to capture savings to satisfy their deficit hawks.
Republicans also floated last week potentially including bipartisan legislation from Sens. Bill Cassidy (R-La.) and Jeff Merkley (D-Ore.) that would target overpayment in Medicare Advantage plans, which enables older Americans to buy private plans offering health coverage. But Finance Committee Republicans are casting doubt on Cassidy-Merkley being included.
House Republicans finalized changes they plan to make to the megabill in order to keep it in line with Senate rules.
An early copy of the amendment House Republicans plan to adopt this week, first obtained by POLITICO, would remove $2 billion for Pentagon military intelligence programs and strike policy that would have allowed mining in a protected wilderness in the Midwest, among other changes. By nixing items flagged by the Senate parliamentarian, the bill will retain its 'privilege' and has a chance at passing the Senate without having to overcome the filibuster.
House GOP leaders plan to adopt the tweaks on the floor Wednesday, Majority Leader Steve Scalise said.
FIRST IN PULSE: HELP DEMS DEMAND — The Democratic roster of the Senate Health, Education, Labor and Pensions Committee is urging Chair Bill Cassidy (R-La.) to hold a hearing and a markup for the Republican reconciliation package, given the House-passed legislation's cuts to federal health programs.
The committee 'has a solemn responsibility to hold extensive hearings on the impact these policies would have on the health and well-being of the American people and our entire health care system,' wrote ranking member Bernie Sanders, an independent who caucuses with Democrats, in a letter sent today.
Minority members asked Cassidy to call providers, hospitals and patients as witnesses.
GRASSLEY, WYDEN BASH CMS ORGAN SYSTEM — A bipartisan report called out conflicts of interests and a lack of transparency surrounding networks responsible for obtaining donated organs for transplant and research.
Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.) released the report Tuesday examining Organ Procurement Organizations. The senators looked into 17 organizations and found CMS doesn't have uniform conflict of interest requirements.
'As millions of American families know first-hand, the organ donation system is a matter of life and death,' said Grassley in a statement. 'It's critical to restore integrity to this system and to strengthen the public's trust in it.'
Why it matters: The senators said that the 55 organizations face 'little-to-no consequences for underperformance' and that CMS has never decertified an organization.
CMS also does not require an organization to follow uniform conflict of interest policies. For instance, organizations don't have to collect details on financial relationships or board member compensation.
TELEHEALTH COMES TO WASHINGTON — The advocacy arm of the American Telemedicine Association is hitting Capitol Hill offices today to lobby lawmakers to make eased Medicare telehealth rules permanent, create a benefit category for prescription digital therapeutics in Medicare and Medicaid and implement other policies.
AROUND THE AGENCIES
NIH IN THE HOT SEAT — NIH Director Jay Bhattacharya testified before a Senate Appropriations panel Tuesday and offered a lukewarm defense of the 40 percent cut the Trump administration has proposed for his agency.
Asked to defend the administration's fiscal 2026 budget plan, which also calls for a major agency reorganization, Bhattacharya repeatedly demurred, saying, 'the budget is a collaboration between Congress and the administration.'
Bhattcharya also distanced himself from President Donald Trump's fight with universities and Elon Musk's Department of Government Efficiency, which led a cost-cutting campaign before Bhattacharya's March confirmation.
Bhattacharya called that period — when the NIH proposed to cap the rates it pays university grantees to cover their administrative costs, laid off hundreds of probationary workers and began an assault on universities Trump accuses of antisemitism — 'a very bumpy time.'
His testimony annoyed Democrats. In one representative exchange, Sen. Dick Durbin of Illinois asked Bhattacharya to take responsibility for Trump's move to freeze funding for Northwestern University, based in a Chicago suburb, leading to a tense back-and-forth.
'The buck stops in your office,' Durbin said.
'I know it does,' Bhattacharya responded.
WHAT WE'RE READING
An analysis from KFF policy analyst Jared Ortaliza found that changes in the One Big Beautiful Bill Act that will impact the Affordable Care Act marketplaces and are projected to increase the number of uninsured people would disproportionately impact southern red states like Florida.
The Boston Globe's Jonathan Saltzman examines the impact the Trump administration and the Massachusetts biopharma downturn have had on mRNA vaccine maker Moderna.
The Trump administration's battle with Harvard University is starting to impact its AIDS research center and projects at affiliated hospitals, Bloomberg's Cam Baker and Greg Ryan report.